Population-Based Disparities in Inferior Vena Cava Filter Procedures Among Medicare Enrollees With Acute Venous Thromboembolism

Williams, Abimbola Onigbanjo; Sridharan, Natalie; Rojanasarot, Sirikan; Chaer, Rabih A.; Anderson, Nicholas; Wifler, Wendy; Jaff, Michael R.

doi:10.1016/j.jacr.2022.03.011

Cited by 7 publications

(1 citation statement)

References 31 publications

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“…61 More broadly, several factors are associated with a higher rate of IVC filter placement; these include advanced age; male gender; White race; residing in the Northeast, South, or West census region; and a higher comorbidity score. 62 Some of these patient factors are also associated with under- retrieval: older age, residing in the Northeast or South census region, and greater comorbidity score. Among those who do have their device removed, Black patients, on average, encountered longer wait times for the retrieval procedure compared to their White counterparts.…”

Section: Disparities By Disease Groupmentioning

confidence: 99%

A Review of Healthcare Disparities Relevant to Interventional Radiology

Marchak,

Singh,

Malavia

et al. 2023

Semin intervent Radiol

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Racial, ethnic, and gender disparities have received focused attention recently, as they became more visible in the COVID era. We continue to learn more about how healthcare disparities manifest for our patients and, more broadly, the structural underpinnings that result in predictable outcomes gaps. This review summarizes what we know about disparities relevant to interventional radiologists. The prevalence and magnitude of disparities are quantified and discussed where relevant. Specific examples are provided to demonstrate how factors like gender, ethnicity, social status, geography, etc. interact to create inequities in the delivery of interventional radiology (IR) care. Understanding and addressing health disparities in IR is crucial for improving real-world patient outcomes and reducing the economic burden associated with ineffective and low-value care. Finally, the importance of intentional mentorship, outreach, education, and equitable distribution of high-quality healthcare to mitigate these disparities and promote health equity in interventional radiology is discussed.

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Section: Disparities By Disease Groupmentioning

confidence: 99%

A Review of Healthcare Disparities Relevant to Interventional Radiology

Marchak,

Singh,

Malavia

et al. 2023

Semin intervent Radiol

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Postmarketing Surveillance of Inferior Vena Cava Filters Among US Medicare Beneficiaries

Ferro,

Mackel,

Kramer

et al. 2024

JAMA

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ImportanceInferior vena cava filters (IVCFs) are commonly used to prevent pulmonary embolism in selected clinical scenarios, despite limited evidence to support their use. Current recommendations from professional societies and the US Food and Drug Administration endorse timely IVCF retrieval when clinically feasible. Current IVCF treatment patterns and outcomes remain poorly described.ObjectivesTo evaluate temporal trends and practice patterns in IVCF insertion and retrieval among older US patients and report the incidence of periprocedural and long-term safety events of indwelling and retrieved IVCFs.Design, Setting, and ParticipantsPrespecified, retrospective, observational cohort of Medicare Fee-for-Service (FFS) beneficiaries, leveraging 100% of samples of inpatient and outpatient claims data from January 1, 2013, to December 31, 2021.ExposureFirst-time IVCF insertion while insured by Medicare FFS.Main Outcomes and MeasuresThe primary safety outcome was the composite of all-cause death, filter-related complications (eg, fracture, embolization), operating room visits following filter-related procedures, or new diagnosis of deep vein thrombosis (DVT). Events were considered periprocedural if they occurred within 30 days of IVCF insertion or retrieval and long-term if they occurred more than 30 days after.ResultsAmong 270 866 patients with IVCFs placed during the study period (mean age, 75.1 years; 52.8% female), 64.9% were inserted for first-time venous thromboembolism (VTE), 26.3% for recurrent VTE, and 8.8% for VTE prophylaxis. Of these patients, 63.3% had major bleeds or trauma within 30 days of IVCF insertion. The volume of insertions decreased from 44 680 per year in 2013 to 19 501 per year in 2021. The cumulative incidence of retrieval was 15.3% at a median of 1.2 years and 16.8% at maximum follow-up of 9.0 years. Older age, more comorbidities, and Black race were associated with a decreased likelihood of retrieval, whereas placement at a large teaching hospital was associated with an increased likelihood of retrieval. The incidence of caval thrombosis and DVT among patients with nonretrieved IVCFs was 2.2% (95% CI, 2.1%-2.3%) and 9.2% (95% CI, 9.0%-9.3%), respectively. The majority (93.5%) of retrieval attempts were successful, with low incidence of 30-day complications (mortality, 0.7% [95% CI, 0.6%-0.8%]; filter-related complications, 1.4% [95% CI, 1.2%-1.5%]).Conclusions and RelevanceIn this large, US real-world analysis, IVCF insertion declined, yet retrievals remained low. Strategies to increase timely retrieval are needed, as nonretrieved IVCFs may have long-term complications.

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Vena Cava Filter

Debus,

Grundmann

2023

Evidence-Based Therapy in Vascular Surgery

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Population-Based Disparities in Inferior Vena Cava Filter Procedures Among Medicare Enrollees With Acute Venous Thromboembolism

Cited by 7 publications

References 31 publications

A Review of Healthcare Disparities Relevant to Interventional Radiology

A Review of Healthcare Disparities Relevant to Interventional Radiology

Postmarketing Surveillance of Inferior Vena Cava Filters Among US Medicare Beneficiaries

Vena Cava Filter

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